Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals

Axana Rodriguez-Torres, Meredith Murphy, Christina Kourkoulis, Kristin Schwab, Alison M. Ayres, Charles J. Moomaw, Soo Young Kwon, Jimmy V. Berthaud, M. Edip Gurol, Steven M. Greenberg, Anand Viswanathan, Christopher D. Anderson, Matthew Flaherty, Michael L. James, Lee Birnbaum, Gene Yong Sung, Gunjan Parikh, Amelia K. Boehme, Douglas Mayson, Kevin N. Sheth & 8 others Chelsea Kidwell, Sebastian Koch, Michael Frankel, Carl D. Langefeld, Fernando D. Testai, Daniel Woo, Jonathan Rosand, Alessandro Biffi

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To clarify whether recurrence risk for intracerebral hemorrhage (ICH) is higher among black and Hispanic individuals and whether this disparity is attributable to differences in blood pressure (BP) measurements and their variability. METHODS: We analyzed data from survivors of primary ICH enrolled in 2 separate studies: (1) the longitudinal study conducted at Massachusetts General Hospital (n = 759), and (2) the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study (n = 1,532). Participants underwent structured interview at enrollment (including self-report of race/ethnicity) and were followed longitudinally via phone calls and review of medical records. We captured systolic BP (SBP) and diastolic BP measurements, and quantified variability as SBP and diastolic BP variation coefficients. We used multivariable (Cox regression) survival analysis to identify risk factors for ICH recurrence. RESULTS: We followed 2,291 ICH survivors (1,121 white, 529 black, 605 Hispanic, and 36 of other race/ethnicity). Both black and Hispanic patients displayed higher SBP during follow-up (p < 0.05). Black participants also displayed greater SBP variability during follow-up (p = 0.032). In univariable analyses, black and Hispanic patients were at higher ICH recurrence risk (p < 0.05). After adjusting for BP measurements and their variability, both Hispanic (hazard ratio = 1.51, 95% confidence interval 1.14-2.00, p = 0.004) and black (hazard ratio = 1.98, 95% confidence interval 1.36-2.86, p < 0.001) patients remained at higher risk of ICH recurrence. CONCLUSION: Black and Hispanic patients are at higher risk of ICH recurrence; hypertension severity (average BP and its variability) does not fully account for this finding. Additional studies will be required to further elucidate determinants for this health disparity.

Original languageEnglish (US)
Pages (from-to)e37-e44
JournalNeurology
Volume91
Issue number1
DOIs
StatePublished - Jul 3 2018

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Cerebral Hemorrhage
Hispanic Americans
Blood Pressure
Hypertension
Recurrence
Survivors
Confidence Intervals
hydroquinone
Survival Analysis
General Hospitals
Self Report
Medical Records
Longitudinal Studies
Regression Analysis
Interviews
Health

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Rodriguez-Torres, A., Murphy, M., Kourkoulis, C., Schwab, K., Ayres, A. M., Moomaw, C. J., ... Biffi, A. (2018). Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals. Neurology, 91(1), e37-e44. https://doi.org/10.1212/WNL.0000000000005729

Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals. / Rodriguez-Torres, Axana; Murphy, Meredith; Kourkoulis, Christina; Schwab, Kristin; Ayres, Alison M.; Moomaw, Charles J.; Young Kwon, Soo; Berthaud, Jimmy V.; Gurol, M. Edip; Greenberg, Steven M.; Viswanathan, Anand; Anderson, Christopher D.; Flaherty, Matthew; James, Michael L.; Birnbaum, Lee; Yong Sung, Gene; Parikh, Gunjan; Boehme, Amelia K.; Mayson, Douglas; Sheth, Kevin N.; Kidwell, Chelsea; Koch, Sebastian; Frankel, Michael; Langefeld, Carl D.; Testai, Fernando D.; Woo, Daniel; Rosand, Jonathan; Biffi, Alessandro.

In: Neurology, Vol. 91, No. 1, 03.07.2018, p. e37-e44.

Research output: Contribution to journalArticle

Rodriguez-Torres, A, Murphy, M, Kourkoulis, C, Schwab, K, Ayres, AM, Moomaw, CJ, Young Kwon, S, Berthaud, JV, Gurol, ME, Greenberg, SM, Viswanathan, A, Anderson, CD, Flaherty, M, James, ML, Birnbaum, L, Yong Sung, G, Parikh, G, Boehme, AK, Mayson, D, Sheth, KN, Kidwell, C, Koch, S, Frankel, M, Langefeld, CD, Testai, FD, Woo, D, Rosand, J & Biffi, A 2018, 'Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals', Neurology, vol. 91, no. 1, pp. e37-e44. https://doi.org/10.1212/WNL.0000000000005729
Rodriguez-Torres A, Murphy M, Kourkoulis C, Schwab K, Ayres AM, Moomaw CJ et al. Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals. Neurology. 2018 Jul 3;91(1):e37-e44. https://doi.org/10.1212/WNL.0000000000005729
Rodriguez-Torres, Axana ; Murphy, Meredith ; Kourkoulis, Christina ; Schwab, Kristin ; Ayres, Alison M. ; Moomaw, Charles J. ; Young Kwon, Soo ; Berthaud, Jimmy V. ; Gurol, M. Edip ; Greenberg, Steven M. ; Viswanathan, Anand ; Anderson, Christopher D. ; Flaherty, Matthew ; James, Michael L. ; Birnbaum, Lee ; Yong Sung, Gene ; Parikh, Gunjan ; Boehme, Amelia K. ; Mayson, Douglas ; Sheth, Kevin N. ; Kidwell, Chelsea ; Koch, Sebastian ; Frankel, Michael ; Langefeld, Carl D. ; Testai, Fernando D. ; Woo, Daniel ; Rosand, Jonathan ; Biffi, Alessandro. / Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals. In: Neurology. 2018 ; Vol. 91, No. 1. pp. e37-e44.
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title = "Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals",
abstract = "OBJECTIVE: To clarify whether recurrence risk for intracerebral hemorrhage (ICH) is higher among black and Hispanic individuals and whether this disparity is attributable to differences in blood pressure (BP) measurements and their variability. METHODS: We analyzed data from survivors of primary ICH enrolled in 2 separate studies: (1) the longitudinal study conducted at Massachusetts General Hospital (n = 759), and (2) the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study (n = 1,532). Participants underwent structured interview at enrollment (including self-report of race/ethnicity) and were followed longitudinally via phone calls and review of medical records. We captured systolic BP (SBP) and diastolic BP measurements, and quantified variability as SBP and diastolic BP variation coefficients. We used multivariable (Cox regression) survival analysis to identify risk factors for ICH recurrence. RESULTS: We followed 2,291 ICH survivors (1,121 white, 529 black, 605 Hispanic, and 36 of other race/ethnicity). Both black and Hispanic patients displayed higher SBP during follow-up (p < 0.05). Black participants also displayed greater SBP variability during follow-up (p = 0.032). In univariable analyses, black and Hispanic patients were at higher ICH recurrence risk (p < 0.05). After adjusting for BP measurements and their variability, both Hispanic (hazard ratio = 1.51, 95{\%} confidence interval 1.14-2.00, p = 0.004) and black (hazard ratio = 1.98, 95{\%} confidence interval 1.36-2.86, p < 0.001) patients remained at higher risk of ICH recurrence. CONCLUSION: Black and Hispanic patients are at higher risk of ICH recurrence; hypertension severity (average BP and its variability) does not fully account for this finding. Additional studies will be required to further elucidate determinants for this health disparity.",
author = "Axana Rodriguez-Torres and Meredith Murphy and Christina Kourkoulis and Kristin Schwab and Ayres, {Alison M.} and Moomaw, {Charles J.} and {Young Kwon}, Soo and Berthaud, {Jimmy V.} and Gurol, {M. Edip} and Greenberg, {Steven M.} and Anand Viswanathan and Anderson, {Christopher D.} and Matthew Flaherty and James, {Michael L.} and Lee Birnbaum and {Yong Sung}, Gene and Gunjan Parikh and Boehme, {Amelia K.} and Douglas Mayson and Sheth, {Kevin N.} and Chelsea Kidwell and Sebastian Koch and Michael Frankel and Langefeld, {Carl D.} and Testai, {Fernando D.} and Daniel Woo and Jonathan Rosand and Alessandro Biffi",
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TY - JOUR

T1 - Hypertension and intracerebral hemorrhage recurrence among white, black, and Hispanic individuals

AU - Rodriguez-Torres, Axana

AU - Murphy, Meredith

AU - Kourkoulis, Christina

AU - Schwab, Kristin

AU - Ayres, Alison M.

AU - Moomaw, Charles J.

AU - Young Kwon, Soo

AU - Berthaud, Jimmy V.

AU - Gurol, M. Edip

AU - Greenberg, Steven M.

AU - Viswanathan, Anand

AU - Anderson, Christopher D.

AU - Flaherty, Matthew

AU - James, Michael L.

AU - Birnbaum, Lee

AU - Yong Sung, Gene

AU - Parikh, Gunjan

AU - Boehme, Amelia K.

AU - Mayson, Douglas

AU - Sheth, Kevin N.

AU - Kidwell, Chelsea

AU - Koch, Sebastian

AU - Frankel, Michael

AU - Langefeld, Carl D.

AU - Testai, Fernando D.

AU - Woo, Daniel

AU - Rosand, Jonathan

AU - Biffi, Alessandro

PY - 2018/7/3

Y1 - 2018/7/3

N2 - OBJECTIVE: To clarify whether recurrence risk for intracerebral hemorrhage (ICH) is higher among black and Hispanic individuals and whether this disparity is attributable to differences in blood pressure (BP) measurements and their variability. METHODS: We analyzed data from survivors of primary ICH enrolled in 2 separate studies: (1) the longitudinal study conducted at Massachusetts General Hospital (n = 759), and (2) the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study (n = 1,532). Participants underwent structured interview at enrollment (including self-report of race/ethnicity) and were followed longitudinally via phone calls and review of medical records. We captured systolic BP (SBP) and diastolic BP measurements, and quantified variability as SBP and diastolic BP variation coefficients. We used multivariable (Cox regression) survival analysis to identify risk factors for ICH recurrence. RESULTS: We followed 2,291 ICH survivors (1,121 white, 529 black, 605 Hispanic, and 36 of other race/ethnicity). Both black and Hispanic patients displayed higher SBP during follow-up (p < 0.05). Black participants also displayed greater SBP variability during follow-up (p = 0.032). In univariable analyses, black and Hispanic patients were at higher ICH recurrence risk (p < 0.05). After adjusting for BP measurements and their variability, both Hispanic (hazard ratio = 1.51, 95% confidence interval 1.14-2.00, p = 0.004) and black (hazard ratio = 1.98, 95% confidence interval 1.36-2.86, p < 0.001) patients remained at higher risk of ICH recurrence. CONCLUSION: Black and Hispanic patients are at higher risk of ICH recurrence; hypertension severity (average BP and its variability) does not fully account for this finding. Additional studies will be required to further elucidate determinants for this health disparity.

AB - OBJECTIVE: To clarify whether recurrence risk for intracerebral hemorrhage (ICH) is higher among black and Hispanic individuals and whether this disparity is attributable to differences in blood pressure (BP) measurements and their variability. METHODS: We analyzed data from survivors of primary ICH enrolled in 2 separate studies: (1) the longitudinal study conducted at Massachusetts General Hospital (n = 759), and (2) the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study (n = 1,532). Participants underwent structured interview at enrollment (including self-report of race/ethnicity) and were followed longitudinally via phone calls and review of medical records. We captured systolic BP (SBP) and diastolic BP measurements, and quantified variability as SBP and diastolic BP variation coefficients. We used multivariable (Cox regression) survival analysis to identify risk factors for ICH recurrence. RESULTS: We followed 2,291 ICH survivors (1,121 white, 529 black, 605 Hispanic, and 36 of other race/ethnicity). Both black and Hispanic patients displayed higher SBP during follow-up (p < 0.05). Black participants also displayed greater SBP variability during follow-up (p = 0.032). In univariable analyses, black and Hispanic patients were at higher ICH recurrence risk (p < 0.05). After adjusting for BP measurements and their variability, both Hispanic (hazard ratio = 1.51, 95% confidence interval 1.14-2.00, p = 0.004) and black (hazard ratio = 1.98, 95% confidence interval 1.36-2.86, p < 0.001) patients remained at higher risk of ICH recurrence. CONCLUSION: Black and Hispanic patients are at higher risk of ICH recurrence; hypertension severity (average BP and its variability) does not fully account for this finding. Additional studies will be required to further elucidate determinants for this health disparity.

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DO - 10.1212/WNL.0000000000005729

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